Association of Oncologist-Patient Communication With Functional Status and Physical Performance in Older Adults

Jensen-Battaglia, Marielle; Lei, Lianlian; Xu, Huiwen; Kehoe, Lee; Patil, Amita; Loh, Kah Poh; Ramsdale, Erika; Magnuson, Allison; Kleckner, Amber S.; Wildes, Tanya M.; Lin, Po‐Ju; Mustian, Karen M.; Giri, Gilbert; Whitehead, Mary; Bearden, James D.; Burnette, Brian L.; Geer, Jodi; Mohile, Supriya G.; Dunne, Richard F.

doi:10.1001/jamanetworkopen.2022.3039

Cited by 6 publications

(9 citation statements)

References 71 publications

(132 reference statements)

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“…Excluding 13 patients (2.4%) who were missing audio recordings or had protocol violations (CONSORT previously published 45 ), an unadjusted 190 patients in the intervention group and 23 in the usual care group had any conversation with their oncologist about falls. As shown in Figure 1, 61.3% (95% CI, 50.9 to 70.8) of those in the intervention group had a conversation about falls compared with only 10.3% (95% CI, 6.0 to 17.0) in usual care ( P < .001).…”

Section: Resultsmentioning

confidence: 99%

“…This GA intervention has been shown to affect the quantity and quality of conversations regarding geriatric syndromes including polypharmacy, 55 comorbidities, 44 and physical function. 45 Implementation of GA in oncology practice settings has the potential to increase awareness of fall risk and fall risk management.…”

Section: Discussionmentioning

confidence: 99%

“…51,52 Previous analysis of this trial found falls were the most commonly discussed aging-related concern and oncologists were more likely to provide recommendations (referrals, physical examination, treatment modification, information, or medication review) for patients having conversations about falls in the intervention group than usual care. 45 A recent study of 718 older adults with incurable cancers showed providing oncologists with a GA report and recommendations led to a 42% lower risk of falls over the following 3 months. 52 The present analysis suggests GA intervention may reduce fall risk in part by promoting conversations about falls on the basis of objective measures of fall risk such as physical performance and history of falls.…”

Section: Discussionmentioning

confidence: 99%

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Communication About Fall Risk in Community Oncology Practice: The Role of Geriatric Assessment

Jensen-Battaglia

Lei

et al. 2022

JCO Oncology Practice

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PURPOSE: Falls are a modifiable source of morbidity for older adults with cancer, yet are underassessed in oncology practice. In this secondary analysis of a nationwide cluster-randomized controlled trial, we examined characteristics associated with patient-oncologist conversations about falls, and whether oncologist knowledge of geriatric assessment (GA) resulted in more conversations. METHODS: Eligible patients (ClinicalTrials.gov identifier: NCT02107443 ) were age ≥ 70 years, had stage III/IV solid tumor or lymphoma, were being treated with noncurative treatment intent, and ≥ 1 GA domain impairment. Patients in both arms underwent GA. At practices randomly assigned to the intervention arm, oncologists were provided a GA summary with management recommendations. In both arms, patients had one clinical encounter audio-recorded, transcribed, and coded to categorize whether a conversation about falls occurred. Generalized linear mixed models adjusted for arm, practice site, and other important covariates were used to generate proportions and odds ratios (ORs) from the full sample. RESULTS: Of 541 patients (intervention N = 293 and usual care N = 248, mean age: 77 years, standard deviation: 5.3), 528 had evaluable audio recordings. More patients had conversations about falls in the intervention versus usual care arm (61.3% v 10.3%, P < .001). Controlling for the intervention and practice site, history of falls (OR, 2.1; 95% CI, 1.3 to 3.6; P = .005) and impaired physical performance (OR, 4.7; 95% CI, 1.7 to 12.8; P = .002) were significantly associated with patient-oncologist conversations about falls. CONCLUSION: GA intervention increased conversations about falls. History of falls and impaired physical performance were associated with patient-oncologist conversations about falls in community oncology practice.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Communication About Fall Risk in Community Oncology Practice: The Role of Geriatric Assessment

Jensen-Battaglia

Lei

et al. 2022

JCO Oncology Practice

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“…As a result of these potential advantages, the deployment of DHTs for capturing clinical research data has attracted attention from drug developers, academic researchers, regulators, and payers for more than a decade 21 . However, the extent of DHT adoption in oncology is somewhat behind other therapeutic areas, such as musculoskeletal and neurological disorders, 21 in part, due to the competing demands associated with managing patients on therapies with significant toxicities, and the fact that many patients suffering from cancer are older 4 . Currently, the most widely used applications of DHTs in oncology are electronic PROs (ePROs) and adverse event diaries administered electronically, along with wearable digital tools for estimating physical activity, and, to a lesser extent, vital signs and sleep parameters before, during, and after anticancer therapies.…”

Section: Capturing Aspects Of Functional Status Using Digital Health ...mentioning

confidence: 99%

A proposed multi‐domain, digital model for capturing functional status and health‐related quality of life in oncology

Izmailova,

Wagner,

Bakker

et al. 2024

Clinical Translational Sci

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Whereas traditional oncology clinical trial endpoints remain key for assessing novel treatments, capturing patients' functional status is increasingly recognized as an important aspect for supporting clinical decisions and assessing outcomes in clinical trials. Existing functional status assessments suffer from various limitations, some of which may be addressed by adopting digital health technologies (DHTs) as a means of collecting both objective and self‐reported outcomes. In this mini‐review, we propose a device‐agnostic multi‐domain model for oncology capturing functional status, which includes physical activity data, vital signs, sleep variables, and measures related to health‐related quality of life enabled by connected digital tools. By using DHTs for all aspects of data collection, our proposed model allows for high‐resolution measurement of objective data as patients navigate their daily lives outside of the hospital setting. This is complemented by electronic questionnaires administered at intervals appropriate for each instrument. Preliminary testing and practical considerations to address before adoption are also discussed. Finally, we highlight multi‐institutional pre‐competitive collaborations as a means of successfully transitioning the proposed digitally enabled data collection model from feasibility studies to interventional trials and care management.

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“…A total of 15 publications met eligibility criteria and form the evidentiary basis for the guideline recommendation pertaining to Clinical Question 1. 3,4,[14][15][16][17][18][19][20][21][22][23][24] The identified publications include the respective primary reports of nine RCTs evaluating GAM 3,4,[14][15][16][17][18][19][20] ; four reports of secondary analyses of data from the primary RCTs [23][24][25][26] ; one systematic review of GA studies 22 ; and one systematic review of GA studies with meta-analysis. 21 The identified RCTs were published between 2020 and 2022.…”

Section: Characteristics Of Studies Identified In the Literature Sear...mentioning

confidence: 99%

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

Dale

Klepin

Williams

et al. 2023

JCO

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108

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PURPOSE To update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy. METHODS An Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022. RESULTS A total of 26 publications met eligibility criteria and form the evidentiary basis for the update. RECOMMENDATIONS The Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (65+ years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate. The Panel recommends the Practical Geriatric Assessment as one option for this purpose ( https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf ; https://youtu.be/jnaQIjOz2Dw ; https://youtu.be/nZXtwaGh0Z0 ). Additional information is available at www.asco.org/supportive-care-guidelines .

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Association of Oncologist-Patient Communication With Functional Status and Physical Performance in Older Adults

Cited by 6 publications

References 71 publications

Communication About Fall Risk in Community Oncology Practice: The Role of Geriatric Assessment

Communication About Fall Risk in Community Oncology Practice: The Role of Geriatric Assessment

A proposed multi‐domain, digital model for capturing functional status and health‐related quality of life in oncology

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

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